Checks & Balances to Better Manage Risk
The transformation of healthcare continues in an ever-changing regulatory environment. Organizations must continually re-examine processes to ensure regulatory and contract compliance. Physician alignment is a major area of concern for hospitals and health systems as new physician arrangements and the complexity of contracts can significantly elevate risk.
Physician compensation is among one of the most common risks related to regulatory compliance. Problems often arise due to poorly designed or inefficient internal controls. Contract terms may not be satisfied, resulting in legal issues related to Stark Law, anti-kickback, fraud and abuse statutes. Financial, legal and reputational consequence can arise as well.
With the intense scrutiny on physician compensation arrangements by the DOJ and OIG, random audits of physician contracts, which include pay for performance dollars, can identify vulnerabilities and opportunities to better mitigate risk.
Dynafios provides objective, credible and timely auditing to assess and mitigate compliance risk. Our multi-disciplinary approach provides thorough and complete oversight and direction to internal processes. Dynafios analyzes internal processes and controls to identify inefficiencies in workflows—inefficiencies that misalign with strategy and contract terms. We then provide recommendations to bridge gaps to reduce risk and improve contract compliance.
Dynafios takes a structured approach to:
- Randomly select a statistically significant number of pay for performance contracts to audit
- Clarify workflows, roles and responsibilities
- Ensure completeness and alignment of all documentation (e.g.; contracts, payments, supporting documents, fair market value)
- Review and reconcile all supporting documents and physician payments
- Link physician performance and payments to contract terms
- Report findings including detailing issues and recommendations for improvement
Don’t let risk manage you; rather, implement controls to elevate compliance. Contact Dynafios about our auditing services to ensure you and your organization are fully compliant. Call 887.858.3282 today.